Methamphetamine injectors are at high risk for HIV infection because of their risky sexual behavior and injection practices. The Multnomah County Health Department proposes to use peer educators to deliver a promising HIV risk-reduction approach to a population of methamphetamine injecting drug users who may be unavailable for interventions. Specifically, we will develop and pilot test a program that uses secondary exchangers-methamphetamine injectors who frequent our Syringe Exchange Program (SEP) and who provide syringes from the exchange to others-as peer educators to deliver HIV risk reduction messages to methamphetamine-injecting recipients who do not regularly attend an SEP site themselves. Peer educators will be trained to assist recipients in reducing their risk of HIV, hepatitis C (HCV) and STD infection. The risk reduction strategy will be based on a brief counseling model, and will include communication and intervention approaches from motivational interviewing. In addition to risk reduction communications, the intervention will provide recipients with condoms and the offer of referrals to HIV counseling and testing, HCV screening, hepatitis A and B vaccinations, STD testing and treatment, drug treatment, and other health and social services. In this exploratory study we will: 1) develop the intervention during a formative phase that involves both secondary exchangers and recipients in the design of project's activities, 2) train 16 secondary exchangers to deliver the intervention, and 3) implement the intervention with 40 recipients. Then, using a pre- post single group design, we will describe: 1) the extent to which the intervention was delivered as intended, 2) changes in recipients' HIV risk behaviors, and 3) the degree to which recipients availed themselves of referrals to health and social services. Our approach of using secondary exchangers as peer educators is feasible because our preliminary studies show that secondary exchangers would be eager to participate; sustainable because of its low cost; easily disseminated because its methods are relatively uncomplicated; and broadly adoptable since secondary exchange at SEPs is practiced throughout the nation. Methamphetamine-injecting drug users are at risk for HIV infection and many other diseases because of their drug use and sexual practices, and because they do not come in for needed medical and social services. In this project we will train some injection drug users to help others reduce their risk of HIV infection and to encourage them to get the medical care, drug treatment and social services they need. [unreadable] [unreadable] [unreadable]